BALTIMORE, MD; November 1, 2012—Parents with social anxiety disorder are more likely than parents with other forms of anxiety to engage in behaviors that put their children at high risk for developing angst of their own, according to a small study of parent-child pairs conducted at Johns Hopkins Children's Center.

Authors of the federally funded study say past research has linked parental anxiety to anxiety in children, but it remained unclear whether people with certain anxiety disorders engaged more often in anxiety-provoking behaviors. Based on the new study findings, they do. A report on the team's findings appears online ahead of print in the journal Child Psychiatry and Human Development.

Specifically, the Johns Hopkins researchers identified a subset of behaviors in parents with social anxiety disorder—the most prevalent type of anxiety—and in doing so clarified some of the confusion that has shrouded the trickle-down anxiety often seen in parent-child pairs.

These behaviors included a lack of or insufficient warmth and affection and high levels of criticism and doubt leveled at the child. Such behaviors, the researchers say, are well known to increase anxiety in children and—if engaged in chronically—can make it more likely for children to develop a full-blown anxiety disorder of their own, the investigators say.

"There is a broad range of anxiety disorders so what we did was home in on social anxiety, and we found that anxiety-promoting parental behaviors may be unique to the parent's diagnosis and not necessarily common to all those with anxiety," says study senior investigator Golda Ginsburg, Ph.D., a child anxiety expert at Johns Hopkins Children's Center and professor of child and adolescent psychiatry at The Johns Hopkins School of Medicine.

The Johns Hopkins team emphasizes that the study did not directly examine whether the parents' behaviors led to anxiety in the children, but because there is plenty of evidence they do, the researchers say physicians who treat parents with social anxiety should be on alert about the potential impact on offspring.

"Parental social anxiety should be considered a risk factor for childhood anxiety, and physicians who care for parents with this disorder would be wise to discuss that risk with their patients," Ginsburg said.

Anxiety is the result of a complex interplay between genes and environment, the researchers say, and while there's not much to be done about one's genetic makeup, controlling external factors can go a long way toward mitigating or preventing anxiety in the offspring of anxious parents.

"Children with an inherited propensity to anxiety do not just become anxious because of their genes, so what we need are ways to prevent the environmental catalysts—in this case, parental behaviors—from unlocking the underlying genetic mechanisms responsible for the disease," Ginsburg says.

The researchers analyzed interactions between 66 anxious parents and their 66 children, ages 7 to 12. Among the parents, 21 had been previously diagnosed with social anxiety, and 45 had been diagnosed with another anxiety disorder, including generalized anxiety disorder, panic disorder and obsessive-compulsive disorder. The parent-child pairs were asked to work together on two tasks: to prepare speeches about themselves and to replicate increasingly complex designs using an Etch-a-Sketch device. The participants were given five minutes for each task and worked in rooms under video surveillance.

Using a scale of 1 to 5, the researchers rated parental warmth and affection toward the child, criticism of the child, expression of doubts about a child's performance and ability to complete the task, granting of autonomy and parental over-control. Parents diagnosed with social anxiety showed less warmth and affection toward their children, criticized them more and more often expressed doubts about a child's ability to perform the task. There were no significant differences between parents on controlling and autonomy-granting behavior.

Prevention of childhood anxiety is critical because anxiety disorders affect one in five U.S. children but often go unrecognized, researchers say. Delays in diagnosis and treatment can lead to depression, substance abuse and poor academic performance throughout childhood and well into adulthood.

November 1, 2012

The Johns Hopkins Children's Center offers one of the most comprehensive pediatric medical programs in the country, with more than 92,000 patient visits and nearly 9,000 admissions each year. Hopkins Children's is consistently ranked among the top children's hospitals in the nation. Hopkins Children's is Maryland's largest children's hospital and the only state-designated Trauma Service and Burn Unit for pediatric patients. It has recognized Centers of Excellence in dozens of pediatric subspecialties, including allergy, cardiology, cystic fibrosis, gastroenterology, nephrology, neurology, neurosurgery, oncology, pulmonary, and transplant.